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目的:探讨低位直肠癌行腹腔镜肛提肌切除的腹会阴联合切除术(APE)的安全性,评估其近期疗效。方法:回顾分析2014年10月至2016年3月间40例低位直肠癌行腹腔镜肛提肌切除的APE手术病人的临床资料,研究其手术安全性、恢复情况、并发症、环周切缘及近期疗效。结果:本研究手术时间(138.9±37.6)min,术中出血量(92.2±35.1)m L,术中淋巴结清扫数目(11.9±3.4)枚。无中转开腹,无死亡病例。术中见穿孔1例。术后病理见环周切缘阳性1例。术后造口首次排气时间、恢复流质饮食时间、拔除导尿管时间、住院时间分别为(2.0±1.0)d、(3.1±0.7)d、(9.6±2.1)d、(14.9±1.8)d。术后见会阴切口感染2例,泌尿功能障碍3例,性功能障碍1例。结论:腹腔镜肛提肌切除的APE安全、可行且符合肿瘤根治原则,近期疗效满意。
Objective: To investigate the safety of abdominal perineal resection (APE) undergoing laparoscopic levator aniomyotomy for the treatment of low rectal cancer and to evaluate its short-term curative effect. Methods: The clinical data of 40 patients with APE treated with laparoscopic levator aniomyotomy from October 2014 to March 2016 were analyzed retrospectively. The operative safety, recovery, complications, peripheral margin And the recent efficacy. Results: The operation time (138.9 ± 37.6) min, blood loss during operation (92.2 ± 35.1) m L, and the number of lymph node dissection during operation (11.9 ± 3.4) in this study. No transit lax, no deaths. See intraoperative perforation in 1 case. Surgical pathology, see the positive circumferential margin in 1 case. The time of the first postoperative stoma exhausting, the time of restoring the liquid diet, the time of removing the catheter and the length of hospital stay were (2.0 ± 1.0) d, (3.1 ± 0.7) d, (9.6 ± 2.1) d, (14.9 ± 1.8) d. Postoperative see episiotomy incision in 2 cases, urinary dysfunction in 3 cases, 1 case of sexual dysfunction. Conclusion: Laparoscopic resection of levator ani muscle APE safe, feasible and in line with the principle of radical tumor, the recent satisfactory results.